Interbody fusion was performed on eight cases of lumbar instability;five spondylolisthesis and three spondylolysis. Five cases were operated by anterolateral approach through the retroperitoneal space, and posterior approach on three cases after Cloward. Symptomatic improvement was obtained in almost all cases and complete fusion was observed on the roentgenogram three months later. Ambulation was possible from the immediate postoperative day without external support. While posterior approach has an advantage to observe the nerve root under direct vision, anterolateral approach has the following advantages;It is less destructive to the spinal structures, It can be performed without teasing the neural elements, anterior slipping of the vertebral body can be reduced easily, and its was applicable to the upper lumber level where neural elements qre compact. We believe interbody fusion has definite advantage to obtain strong weight bearing stability than fusion of any other parts of the spine because it has rapid recovery, low morbidity and high percentage of complete cure without disability.
Retroperitoneal Space ; Spine ; Spondylolisthesis ; Spondylolysis ; Walking ; Weight-Bearing

Diabetic calcaneal insufficiency avulsion (CIA) fracture are unusual injury. The treatment may be challenging due to the low healing potential from diabetes or Charcot neuroarthropathy, so far. The poor surgical outcomes and surgical failures from treatment of the traumatic calcaneal avulsion fractures were associated with poor bone stock, lack of proper fixation, and the wound problem. Thus, the proper treatment for diabetic CIA fracture was still controversy. This report described two cases of diabetic CIA fracture treated with fixation of fracture fragment and calcaneal tenodesis. In both cases, fracture fragments were re-avulsed despite of fixation. Through investigation for the fate of fracture fragment from these cases, we discussed the proper treatment strategy in diabetic CIA fracture.
Tenodesis ; Wounds and Injuries

Congenital cystic adenomatoid malformation of the lung (CCAM) is a rare benign pulmonary lesion characterized by abnormal overgrowth of the fetal bronchiole. The prenatal diagnosis of CCAM is important because the prognosis of the CCAM is depend on the type, bilaterality, and other associated abnormalities, which can be detected by prenatal ultrasonography. We experienced a case of CCAM that was detected by prenatal ultrasonography and report the case with a review of several related literatures.
Bronchioles ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Lung* ; Prenatal Diagnosis ; Prognosis ; Ultrasonography, Prenatal

It is necessary to install ventilation facilities in the laboratory and to regularly monitor harmful gases including formalin for safe environment of the dissection laboratory. However, there are no indicators that can identify the current status of ventilation facilities, safety equipment, and protective equipment in the dissection laboratory. In this study, the status of safety management of anatomical lab at domestic medical, dental, and oriental medical universities are investigated through an online questionnaire. Of the total 32 universities, 7 universities (21.8%) regularly monitor harmful gases such as formalin in the dissection lab, 13 universities (40.6%) do it on an irregular basis, and 12 do not do it at all. Seven universities (21.8%) are using the exhaust-type dissection table, 24 universities (75%) are not using it. Regarding the need for standards for manpower and facilities in the management of the anatomy lab, 7 universities (21.8%) are mediocre, 21 universities are necessary (65.6%), and 4 universities (12.5%) are very necessary. The responsibility for anatomy lab is 27 universities (84.3%) of the schools that responded as head professors of the department of anatomy, 3 universities (9.3%) of technicians, and 2 universities (6.2%) of the dean of the medical school. Regarding the need for standards for the anatomical lab, 7 universities (21.8%) are very necessary, 21 universities (65.6%) are necessary, and 4 universities (12.5%) are mediocre. Based on this data, the standard for the quality improvement and safety of anatomical education should be prepared.

This prospective cohort study was performed to estimate the morbidity and mortality with 790 patients over 50-yr of age that sustained a femoral neck or intertrochanteric fracture from 2002 to 2006, followed-up for a mean of 6 yr (range, 4 to 9 yr). Crude and annual standardized mortality ratios (SMRs) were calculated; and mortalities in the cohort and the age and sex matched general population were compared. The risk factors on mortality and activities pre- and post-injury were assessed. Accumulated mortality was 16.7% (132 patients) at 1 yr, 45.8% (337 patients) at 5 yr, and 60% (372 patients) at 8 yr. SMR at 5 yr post-injury was 1.3 times that of the general population. Multivariate analysis demonstrated that age (OR, 1.074; 95% CI, 1.050-1.097; P<0.001), woman (OR, 1.893; 95% CI, 1.207-2.968; P=0.005), and medical comorbidity (OR, 1.334; 95% CI, 1.167-1.524 P<0.001) were independently associated with mortality after hip fracture. Only 59 of the 150 patients (39.3%) who were able to ambulate normally outdoors at preinjury retained this ability at final follow-up. Patients with a hip fracture exhibits higher mortality at up to 5 yr than general population. Age and a preinjury comorbidity are associated with mortality.
Age Factors ; Aged ; Aged, 80 and over ; Aging ; Cohort Studies ; Female ; Hip Fractures/*epidemiology/mortality ; Humans ; Male ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors

Hydatidiform moles are generally separated into two classifications. Complete hydatidiform moles are characterized by cystic swelling of all villi, often pronounced trophoblastic hyperplasia, lack of fetal parts, all 46 chromosomes of paternal origin, and a major risk for persistent trophoblastic tumor. Partial hydatidiform moles appear to be a milder version of complete moles with both normal and cystic villi, focal trophoblastic hyperplsia, a fetus or indication of previous fetal existence, 69 chromosomes with a maternal contribution, and a malignant potential less than described for complete moles. Hydatidiform mole with coexistent fetus is a very rare phenomenon, with an estimated incidence of 0.005 to 0.01 percent of all pregnancies. Due to advances in cytogenetics and ultrasonography, now permit the diagnosis of this pregnancy antenatally. However this unusual pregnancy has the risks of malignant change and severe medical complications, so it is a dilemma to decide continuation or termination of pregnancy. We experienced a case of partial hydatidiform mole with coexistent live fetus, which was diagnosed by ultrasonography at 12 gestational weeks, and confirmed normal karyotype (diploid) of the coexistent fetus. A brief reviews of related literature was done.
Classification ; Cytogenetics ; Diagnosis ; Diploidy ; Female ; Fetus* ; Hydatidiform Mole* ; Hyperplasia ; Incidence ; Karyotype ; Pregnancy ; Trophoblastic Neoplasms ; Trophoblasts ; Ultrasonography

BACKGROUND: Living related liver transplantation (LRLT) has gained acceptance as treatment modality for children with end-stage liver disease. The left lobe used in LRLT doesn't provide adequate parenchymal mass for its application to adults. We have used right lobe for LRLT in adults. Some criticism has been aroused becuase of the potential significant risk to the donors. METHODS: We analyzed the surgical risk and the stress to 20 donors in a right lobectomy for LRLT. We also analyzed anatomical points for safe harvest, and we describe techincal points based on anatomical variations. RESULTS: There were no deaths, and 6 major complications (3 bleeding, 1 perihepatic fluid collection, 1 pleural effusion, and 1 bile peritonitis after removal of the T-tube) occurred in 6 patients. Liver function was normalized within 2 weeks. There were anatomical variations in the hepatic vein, the portal vein, and the bile duct, especially the right inferior hepatic vein (55%), trifurcation of the portal vein (10%), low inserion of the right posterior bile duct into the common hepatic duct (10%), and separate insertion of the right anterior bile duct and right posterior bile duct into the hepatic duct (10%). We made a vena cava patch for the right inferior hepatic vein. In cases of the low insertion of the right posterior hepatic duct into the common hepatic duct, the cholecystectomy should be done carefully so as not to injure the right posterior hepatic duct. We ligated and divided the right posterior bile duct before dissection of the hepatic artery and the portal vein. In cases of trifurcation of the portal vein, closure of the left portal vein should be done to prevent the narrowing of the left portal vein lumen. CONCLUSIONS: Our results suggest that a right lobectomy for LRLT is safe for donors. However, anatomical variations in the bile duct, the hepatic vein, and the portal vein should be kept in mind to ensure a safe and successful operation.
Adult* ; Bile ; Bile Ducts ; Child ; Cholecystectomy ; Hemorrhage ; Hepatic Artery ; Hepatic Duct, Common ; Hepatic Veins ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors* ; Peritonitis ; Pleural Effusion ; Portal Vein ; Tissue Donors

PURPOSE: This study evaluated the prognostic factors of modified Thompson quadricepsplasty for a stiff knee. MATERIALS AND METHODS: From February 1987 to February 2007, 38 knees of 38 patients were managed with modified Thompson quadricepsplasty for a stiff knee. Thirty three males and 5 females were enrolled with a mean age of 36 years. The average follow-up duration was 92 months (range, 18 to 133 months). The most common cause of the stiff knee was a fracture around the knee in 33 cases. Multivariate logistic regression analysis was performed to evaluate the prognostic factors. RESULTS: Multivariate analysis showed that the gain of ROM after surgery was negatively correlated with the ROM before surgery (p<0.0001), and flexion contracture at the last follow up was positively correlated with the initial flexion contracture (p<0.0001). CONCLUSION: In a stiff knee, modified Thompson quadricepsplasty should be considered as soon as possible if the patient cannot gain an acceptable ROM through conservative management. More improvement in the ROM can be obtained in those with a more severe limitation of motion.
Contracture ; Female ; Follow-Up Studies ; Humans ; Knee ; Logistic Models ; Male ; Multivariate Analysis

PURPOSE: The purpose of this study was to evaluate the clinical results and prognostic factors of the extension block technique for treating a bony mallet finger. MATERIALS AND METHODS: Between July 2002 and January 2009, forty-nine patients who underwent the extension block technique for a bony mallet finger were evaluated. The minimum period of follow up was 6 months. The type of fracture was classified by the Wehbe and Schneider method. The results were evaluated by the Crawford classification. The prognostic factors were analyzed according to age, gender, the timing of the surgery, the mallet fragment angle and the residual displacement. RESULTS: According the Crawford classification, there were 22 excellent, 20 good, 6 fair and 1 poor results. The poor prognostic factors were an older patient age, subluxation, a smaller mallet fragment angle and smaller postoperative displacement (p<0.05). CONCLUSION: The prognostic factors of the extension block technique for bony mallet finger were the patient age, subluxation, the mallet fragment angle (more than 30 degrees) and the postoperative displacement.
Displacement (Psychology) ; Fingers ; Follow-Up Studies ; Humans

Purpose: This multicenter study was carried out to estimate the clinical and radiological results of cemented bipolar endoprosthesis replacement arthroplasty of a hip fracture in patients aged over 50 years in Jeju Island. Materials and Methods: Eighty-eight hips underwent bipolar endoprosthesis in 2002. Thirty-two patients died during the follow-up period and 7 patients refused a radiological evaluation or an interview. Two patients who underwent cementless bipolar endoprosthesis were excluded. Forty- nine hips (48 patients) completed the average 27 months follow-up. A neck fracture was involved in 40 hips (39 patient) and an intertrochanteric fracture was involved in 9 hips (9 patients). The average age was 77.7 years. The results were evaluated using clinical and radiological methods. Results: At the last follow-up, the average Harris hip score was 70.1 and 22 hips (45%), which indicated excellent and good results, respectively. Among the 42 patients with normal activity at the preoperative period, 28 patients were still active at the final follow-up. The number of medical illnesses and the severity of mental deterioration were also associated with the poor Harris hip scores. The pressurization cementing technique was found to be excellent at the radiological evaluation. One femoral stem appeared to have loosened and subsided but there was no revision surgery. Conclusion: The clinical result of the cemented bipolar endoprosthesis in multicenter study showed that the only 45% of patients showed results >good. The major factors influencing the results were the postoperative activity, the number of medical illnesses, and the severity of the mental changes.
Aged* ; Arthroplasty, Replacement ; Follow-Up Studies ; Hemiarthroplasty* ; Hip ; Humans ; Neck ; Preoperative Period